Cochlear implantation surgery without posterior tympanotomy: can we still improve it?

Conclusion: The amendments made to pre-existing transcanal approaches limit the possibility of extrusion of the electrode and reduce the time of 'blind' surgery.

Objective: Alternative techniques to classic mastoidectomy and posterior tympanotomy for cochlear implantation have already been described but their main drawbacks result in either: (i) the risk of an electrode extrusion through the skin as the groove is drilled into the auditory canal or (ii) the risk of a facial nerve injury as the tunnel is drilled blindly into the posterior canal wall. The aim of this study was to describe and evaluate a new transcanal approach for cochlear implantation ruling out these difficulties.

Patients And Methods: Through a minimal retroauricular skin incision, a cochleostomy is performed directly via the auditory canal. The passage for the electrode is performed after drilling both a suprameatal hollow and a 1.5 mm hole into the superior-posterior canal wall, which opens the facial recess by an anterior approach. Thanks to this hole a transwall tunnel can afterwards be dug safely.

Results: Twenty-three patients (8 adults, 15 children) were implanted without any difficulty. The mean follow-up was 22 months. No postoperative complication was observed.